Xeljanz_Xeljanz_XR_Prior_Authorization_Criteria
Prior authorization and quantity-limit policy for Xeljanz (tofacitinib) and Xeljanz XR for pharmacy benefit indications including RA, PsA, UC, pcJIA, and ankylosing spondylitis; defines initial and continuation criteria, required prior trials, approval durations, and quantity limits.
Updated criteria for ulcerative colitis to remove disease characteristic requirement and allow approval if disease severity warrants systemic biologic as first-line therapy; initial approval length for UC updated to 24 months.
Specified approvable formulations for each indication and updated reauthorization criteria to require documentation of clinical response.
Updated criteria to be in line with FDA approved indication and removed TB requirement; added examples for each indication and updated conventional therapies.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.